Medical practice and patient care has experienced significant changes over the recent past including huge increases in the number of outpatient medical, surgical, and radiologic procedures. The use of flexible fiberoptic endoscopy for diagnostic and therapeutic procedures has grown worldwide. Conscious sedation and short-acting anesthetic agents have enabled a much greater variety of procedures to be accomplished on an outpatient basis. Because of the brief duration of many of these procedures and the use of conscious sedation, the placement of a mechanical airway is omitted. This may result in manipulation or support of the patient by the nursing or anesthesia staff to maintain an adequate airway during and after a procedure until the patient is fully recovered. Many of these procedures are performed in the lateral position, further complicating patient position and airway management.
The state of medical practice dictates the care of more elderly and of more obese patients, further complicating the positioning and airway management of these patients during a procedure. The patient support addressed in the Troop patent (U.S. Pat. No. 6,751,818) discloses an airway management apparatus which supports the chest, neck, and head of a patient, allowing the abdominal mass to be displaced, thus improving airway position and ventilation. This cushion does not accommodate the lateral position which is widely used.
The Xiang patent (U.S. Pat. No. 5,581,831) addresses the support of a patient in the lateral position for comfort, but the chest is not supported independently of the shoulder, resulting in lateral angulation of the cervical spine and the airway. The shoulder is allowed to impinge on the neck, and the head is not supported in a position to maintain a secure airway. This device also does not support the patient from shifting laterally or easily rolling off of the cushion.
There has been a vast increase in the number of patients in rehabilitation hospitals and extended care facilities requiring the nursing staff to position and move them while they are recumbent. Supporting and cushioning patients to avoid soft tissue pressure injury over a bony prominence is a major priority of patient care. The morbidity and mortality from complications of pressure sores is great and consumes massive financial and personnel resources. Many patients require apnea monitoring during long term care and airway maintenance requires considerable time and attention from nursing and respiratory therapy staff. Techniques of padding and bolstering patients with common bed pillows in the lateral position yield inadequate results and require multiple staff members to reposition patients every two hours.
The treatment of gastroesophageal reflux and congestive heart failure, as well as other conditions, require elevation of the head of the patient's bed. The classic recommendation is to place blocks or bricks under the legs of the bed at the patient's head. Several drawbacks are apparent in this technique. The patient usually slides out the foot of the bed, and a bed partner is made uncomfortable by the position of the bed. The use of blocks or bricks is not possible with a water mattress. The expense of an adjustable hospital bed is prohibitive for most patients. The technique does not lend itself to maintaining good airway support in the head-elevated supine position or the lateral position. Many of these patients are obese and have sleep apnea and the elevated position does not support the head and neck, thus complicating the already compromised airway.
Because of the increased use of the lateral position in diagnostic and therapeutic procedures requiring sedation or anesthesia, without the use of a mechanical airway, attention is drawn to adequate support and positioning of the patient during and after these procedures. Likewise, the use of the lateral position in long term care requires attention to proper positioning, padding, and airway support. Therefore, a medical support pillow that meets these multiple needs is the object of the present invention.
It is therefore an object of the invention to support and stabilize the patient in the lateral position while maintaining an open airway.
It is another object of the invention to enhance spontaneous respiration by aligning the airway in the anterior-posterior, and lateral directions.
It is another object of the invention to assist the anesthesiologist in placing a mechanical airway prior to a procedure requiring the lateral position.
It is another object of the invention to support the patient with limited mobility in such a way to maintain an adequate airway and protect against soft tissue pressure injury.
It is another object of the invention to provide support and elevation of the head, neck and thorax of the patient in the supine, right, or left lateral positions.